{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T07:38:51Z","timestamp":1764056331168,"version":"3.45.0"},"reference-count":53,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,11,8]],"date-time":"2025-11-08T00:00:00Z","timestamp":1762560000000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Reports"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study aimed to evaluate the diagnostic accuracy of the apparent diffusion coefficient (ADC) derived from diffusion weighted imaging (DWI) for detecting lymph node metastasis in breast cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review and meta\u2010analysis was conducted following the PRISMA\u2010DTA guidelines. PubMed, Web of Science, PROQUEST, and EMBASE were searched. ADC values for suspected lymph nodes in breast cancer patients were assessed, with histopathology as the reference test. Data were analyzed using a bivariate meta\u2010analytical model with Meta\u2010DiSc 2.0 and STATA 17. Meta\u2010regression and subgroup analysis were conducted to assess heterogeneity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty\u2010six studies encompassing 2828 participants were included. The pooled sensitivity and specificity of ADC value for detecting lymph node metastasis were 88.6% (CI\u2009=\u200982.4%\u201392.8%) and 83.6% (CI\u2009=\u200978.0%\u201388.1%), respectively. The area under the HSROC curve was 0.92 (CI\u2009=\u20090.89\u20130.94), indicating excellent diagnostic ability. Moderate heterogeneity was detected (prediction area\u2009=\u20090.369; bivariate\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200969.9%). Field of view and retrospective study designs were identified as factors linked with higher specificity. Selection of largest nodes for analysis and participants' age were factors associated with higher sensitivity. The pooled ADC value was 1.272\u2009\u00d7\u200910\n                      <jats:sup>\u22123<\/jats:sup>\n                      \u2009mm\n                      <jats:sup>2<\/jats:sup>\n                      \/s (CI\u2009=\u20091.150\u20131.394) for benign nodes and 0.874\u2009\u00d7\u200910\n                      <jats:sup>\u22123<\/jats:sup>\n                      \u2009mm\n                      <jats:sup>2<\/jats:sup>\n                      \/s (CI\u2009=\u20090.773\u20130.974) for metastatic nodes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      ADC value is a highly accurate non\u2010invasive diagnostic marker for lymph node metastasis in breast cancer. We recommend acquisition of DWI in women less than 51\u2009years old, with the highest\n                      <jats:italic>b<\/jats:italic>\n                      \u2010value of 1000\u2009s\/mm\n                      <jats:sup>2<\/jats:sup>\n                      , repetition time\u2009\u2265\u20098500\u2009ms, field of view \u2265\u2009350\u2009mm, and selection of the largest node for analysis.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cnr2.70395","type":"journal-article","created":{"date-parts":[[2025,11,8]],"date-time":"2025-11-08T13:45:44Z","timestamp":1762609544000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Test Accuracy of Apparent Diffusion Coefficient in Evaluation of Breast Cancer Lymph Node Metastasis: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7030-9535","authenticated-orcid":false,"given":"Amirmohammad","family":"Azizzadeh","sequence":"first","affiliation":[{"name":"Student's Scientific Research Center Tehran University of Medical Sciences  Tehran Iran"},{"name":"Student Research Committee Tabriz University of Medical Sciences  Tabriz Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6652-7759","authenticated-orcid":false,"given":"Fahimeh","family":"Zeinalkhani","sequence":"additional","affiliation":[{"name":"Advanced Diagnostic and Interventional Radiology Research Center (ADIR) Tehran University of Medical Science  Tehran Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9529-9081","authenticated-orcid":false,"given":"Peyman Kamali","family":"Hakim","sequence":"additional","affiliation":[{"name":"Department of Radiology 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